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Gerontechnologies for Older Patients with Heart Failure: What is the Role of Smartphones, Tablets, and Remote Monitoring Devices in Improving Symptom Monitoring and Self-Care Management?

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Abstract

Older adults with heart failure have multiple chronic conditions and a large number and range of symptoms. A fundamental component of heart failure self-care management is regular symptom monitoring. Symptom monitoring can be facilitated by cost-effective, easily accessible technologies that are integrated into patients’ lives. Technologies that are tailored to older adults by incorporating gerontological design principles are called gerontechnologies. Gerontechnology is an interdisciplinary academic and professional field that combines gerontology and technology with the goals of improving prevention, care, and enhancing the quality of life for older adults. The purpose of this article is to discuss the role of gerontechnologies, specifically the use of mobile applications available on smartphones and tablets as well as remote monitoring systems, for outpatient disease management among older adults with heart failure. While largely unproven, these rapidly developing technologies have great potential to improve outcomes among older persons.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Mozaffarian D, Benjamin EJ, Go AS, et al. Heart disease and stroke statistics—2015 update: a report from the American Heart Association. Circulation. 2015.

  2. Heidenreich PA, Trogdon JG, Khavjou OA, et al. Forecasting the future of cardiovascular disease in the United States: a policy statement from the American Heart Association. Circulation. 2011;123(8):933–44.

    Article  PubMed  Google Scholar 

  3. Lloyd-Jones D, Adams RJ, Brown TM, et al. Heart disease and stroke statistics—2010 update: a report from the American Heart Association. Circulation. 2010;121(7):e46–215.

    Article  PubMed  Google Scholar 

  4. Ross JS, Chen J, Lin Z, et al. Recent national trends in readmission rates after heart failure hospitalization. Circ Heart Fail. 2010;3(1):97–103.

    Article  PubMed  Google Scholar 

  5. Jencks SF, Williams MV, Coleman EA. Rehospitalizations among patients in the Medicare fee-for-service program. N Engl J Med. 2009;360(14):1418.

    Article  CAS  PubMed  Google Scholar 

  6. Retrum JH, Boggs J, Hersh A, et al. Patient-identified factors related to heart failure readmissions. Circ Cardiovasc Qual Outcomes. 2013;6(2):171–7.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Roger VL, Go AS, Lloyd-Jones DM, et al. Heart disease and stroke statistics—2012 update: a report from the American Heart Association. Circulation. 2012;125(1):e2–220.

    Article  PubMed  Google Scholar 

  8. Mozaffarian D, Benjamin EJ, Go AS, et al. Executive summary: heart disease and stroke statistics-2016 update: a report from the American Heart Association. Circulation. 2016;133(4):447–54.

    Article  PubMed  Google Scholar 

  9. Khan RF, Feder S, Goldstein NE, Chaudhry SI. Symptom burden among patients who were hospitalized for heart failure. JAMA Intern Med. 2015;175(10):1713–5.

    Article  PubMed  Google Scholar 

  10. Lindenfeld J, Albert NM, Boehmer JP, et al. HFSA 2010 comprehensive heart failure practice guideline. J Card Fail. 2010;16(6):e1–194.

    Article  PubMed  Google Scholar 

  11. Rutledge T, Reis VA, Linke SE, Greenberg BH, Mills PJ. Depression in heart failure a meta-analytic review of prevalence, intervention effects, and associations with clinical outcomes. J Am Coll Cardiol. 2006;48(8):1527–37.

    Article  PubMed  Google Scholar 

  12. Dunlay SM, Chamberlain AM. Multimorbidity in older patients with cardiovascular disease. Curr Cardio Risk Rep. 2016;10(3).

  13. Lainscak M, Blue L, Clark AL, et al. Self-care management of heart failure: practical recommendations from the Patient Care Committee of the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail. 2011;13(2):115–26.

    Article  PubMed  Google Scholar 

  14. van der Wal MH, van Veldhuisen DJ, Veeger NJ, Rutten FH, Jaarsma T. Compliance with non-pharmacological recommendations and outcome in heart failure patients. Eur Heart J. 2010;31(12):1486–93.

    Article  PubMed  Google Scholar 

  15. Zan S, Agboola S, Moore SA, Parks KA, Kvedar JC, Jethwani K. Patient engagement with a mobile web-based telemonitoring system for heart failure self-management: a pilot study. JMIR mHealth uHealth. 2015;3(2), e33.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Mirkovic J, Kaufman DR, Ruland CM. Supporting cancer patients in illness management: usability evaluation of a mobile app. JMIR mHealth uHealth. 2014;2(3), e33.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Alshurafa N, Eastwood JA, Nyamathi S, et al. Improving compliance in remote healthcare systems through smartphone battery optimization. IEEE J Biomed Health Informatics. 2015;19(1):57–63.

    Article  Google Scholar 

  18. Gammon D, Murray E, Franklin VL, et al. Patients’ engagement with “sweet talk” – a text messaging support system for young people with diabetes. J Med Internet Res. 2008;10(2).

  19. Quinn CC, Clough SS, Minor JM, Lender D, Okafor MC, Gruber-Baldini A. WellDoc mobile diabetes management randomized controlled trial: change in clinical and behavioral outcomes and patient and physician satisfaction. Diabetes Technol Ther. 2008;10(3):160–8.

    Article  PubMed  Google Scholar 

  20. Bell AM, Fonda SJ, Walker MS, Schmidt V, Vigersky RA. Mobile phone-based video messages for diabetes self-care support. J Diabetes Sci Technol. 2012;6(2):310–9.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Kiselev AR, Gridnev VI, Shvartz VA, Posnenkova OM, Dovgalevsky PY. Active ambulatory care management supported by short message services and mobile phone technology in patients with arterial hypertension. J Am Soc Hypertens. 2012;6(5):346–55.

    Article  PubMed  Google Scholar 

  22. Morikawa N, Yamasue K, Tochikubo O, Mizushima S. Effect of salt reduction intervention program using an electronic salt sensor and cellular phone on blood pressure among hypertensive workers. Clin Exp Hypertens. 2011;33(4):216–22.

    Article  PubMed  Google Scholar 

  23. Liu WT, Wang CH, Lin HC, et al. Efficacy of a cell phone-based exercise programme for COPD. The Eur Respir J. 2008;32(3):651–9.

    Article  PubMed  Google Scholar 

  24. Peritz DC, Howard A, Ciocca M, Chung EH. Smartphone ECG aids real time diagnosis of palpitations in the competitive college athlete. J Electrocardiol. 2015;48(5):896–9.

    Article  PubMed  Google Scholar 

  25. Muhlestein JB. QTC intervals can be assessed with the AliveCor heart monitor in patients on dofetilide for atrial fibrillation. J Electrocardiol. 2015;48(1):10–1.

    Article  PubMed  Google Scholar 

  26. Haberman ZC, Jahn RT, Bose R, et al. Wireless smartphone ECG enables large-scale screening in diverse populations. J Cardiovasc Electrophysiol. 2015;26(5):520–6.

    Article  PubMed  Google Scholar 

  27. Dharmarajan K, Chaudhry SI. New approaches to reduce readmissions in patients with heart failure. JAMA Intern Med. 2016;176(3):318–20.

    Article  PubMed  Google Scholar 

  28. Chaudhry SI, Mattera JA, Curtis JP, et al. Telemonitoring in patients with heart failure. N Engl J Med. 2010;363(24):2301–9. This article is the largest randomized controlled trial to test the efficacy of telemonitoring in heart failure.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Ong MK, Romano PS, Edgington S, et al. Effectiveness of remote patient monitoring after discharge of hospitalized patients with heart failure: the better effectiveness after transition-heart failure (BEAT-HF) randomized clinical trial. JAMA Intern Med. 2016;176(3):310–8. This article is another large randomized controlled trial testing the efficacy of remote monitoring and transitional care.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Chaudhry SI, Barton B, Mattera J, Spertus J, Krumholz HM. Randomized trial of Telemonitoring to Improve Heart Failure Outcomes (Tele-HF): study design. J Card Fail. 2007;13(9):709–14.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Koehler F, Winkler S, Schieber M, et al. Impact of remote telemedical management on mortality and hospitalizations in ambulatory patients with chronic heart failure: the telemedical interventional monitoring in heart failure study. Circulation. 2011;123(17):1873–80.

    Article  PubMed  Google Scholar 

  32. Piotrowicz E, Baranowski R, Bilinska M, et al. A new model of home-based telemonitored cardiac rehabilitation in patients with heart failure: effectiveness, quality of life, and adherence. Eur J Heart Fail. 2010;12(2):164–71.

    Article  PubMed  Google Scholar 

  33. Scherr D, Kastner P, Kollmann A, et al. Effect of home-based telemonitoring using mobile phone technology on the outcome of heart failure patients after an episode of acute decompensation: randomized controlled trial. J Med Internet Res. 2009;11(3), e34.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Seto E, Leonard KJ, Cafazzo JA, Barnsley J, Masino C, Ross HJ. Mobile phone-based telemonitoring for heart failure management: a randomized controlled trial. J Med Internet Res. 2012;14(1), e31.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Micera S, Bonato P, Tamura T. Gerontechnology. IEEE Eng Med Biol Mag. 2008;27(4):10–4.

    Article  PubMed  Google Scholar 

  36. Graafmans JA, Taipale V. Gerontechnology: a sustainable investment in the future. In: Graafmans JA, Taipale V, Charness N, editors. Gerontechnology: a sustainable investment in the future. Amsterdam: Ios Press; 1998.

    Google Scholar 

  37. Schmitter-Edgecombe M, Seelye A, Cook DJ. Ch. 8: Technologies for health assessment, promotion, and assistance: focus on gerontechnology. In: Randolph JJ, ed. Positive Neuropsychology: Evidence-Based Perspecites on Promoting Cognitive Health: Springer; 2013.

  38. Delello JA, McWhorter RR. Reducing the digital divide: connecting older adults to iPad technology. J Appl Gerontol. 2015.

  39. Pew Research Center. Smartphone ownership—2013 Update. Pew Research Center’s Internet & American Life Project; 2013. This article reports the prevalence of smartphone ownership among adults in the United States.

  40. Pew Research Center. Older adults and technology use. 2014. This article provides an overview of how older adults interact with specific mobile devices.

  41. January CT, Wann LS, Alpert JS, et al. 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: executive summary. J Am Coll Cardiol. 2014;64(21):2246–80.

    Article  Google Scholar 

  42. Hickey KT, Reiffel J, Sciacca RR, et al. The utility of ambulatory electrocardiographic monitoring for detecting silent arrhythmias and clarifying symptom mechanism in an urban elderly population with heart failure and hypertension: clinical implications. J Atr Fibrillation. 2010;1(12):663–74.

    PubMed  PubMed Central  Google Scholar 

  43. Lau JK, Lowres N, Neubeck L, et al. iPhone ECG application for community screening to detect silent atrial fibrillation: a novel technology to prevent stroke. Int J Cardiol. 2013;165(1):193–4.

    Article  PubMed  Google Scholar 

  44. Hickey KT, Hauser NR, Valente LE, et al. A single-center randomized, controlled trial investigating the efficacy of a mHealth ECG technology intervention to improve the detection of atrial fibrillation: the iHEART study protocol. BMC Cardiovasc Disord. In Press.

  45. Worringham C, Rojek A, Stewart I. Development and feasibility of a smartphone, ECG and GPS based system for remotely monitoring exercise in cardiac rehabilitation. PLoS One. 2011;6(2), e14669.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  46. Alshurafa N, Xu W, Liu JJ, et al. Designing a robust activity recognition framework for health and exergaming using wearable sensors. IEEE J Biomed Health Informatics. 2014;18(5):1636–46.

    Article  Google Scholar 

  47. Mercer K, Giangregorio L, Schneider E, Chilana P, Li M, Grindrod K. Acceptance of commercially available wearable activity trackers among adults aged over 50 and with chronic illness: a mixed-methods evaluation. JMIR mHealth uHealth. 2016;4(1), e7.

    Article  PubMed  PubMed Central  Google Scholar 

  48. McMahon SK, Lewis B, Oakes M, Guan W, Wyman JF, Rothman AJ. Older adults’ experiences using a commercially available monitor to self-track their physical activity. JMIR mHealth uHealth. 2016;4(2), e35.

    Article  PubMed  PubMed Central  Google Scholar 

  49. Brooks GC, Vittinghoff E, Iyer S, et al. Accuracy and usability of a self-administered 6-minute walk test smartphone application. Circ Heart Fail. 2015;8(5):905–13.

    Article  PubMed  PubMed Central  Google Scholar 

  50. Howell J, Strong BM, Weisenberg J, et al. Maximum daily 6 minutes of activity: an index of functional capacity derived from actigraphy and its application to older adults with heart failure. J Am Geriatr Soc. 2010;58(5):931–6.

    Article  PubMed  PubMed Central  Google Scholar 

  51. Berry R. Older people and the internet: towards a system map of digital exclusion. London 2011.

  52. Alvseike H, Bronnick K. Feasibility of the iPad as a hub for smart house technology in the elderly; effects of cognition, self-efficacy, and technology experience. J Multidiscip Healthc. 2012;5:299–306.

    Article  PubMed  PubMed Central  Google Scholar 

  53. Bandura A. Self-efficacy: the exercise of control. New York: WH Freeman; 1997.

    Google Scholar 

  54. Hickey KT, Sciacca RR, Gonzalez P, Castillo C, Frulla A. Assessing health literacy in urban patients with implantable cardioverter defibrillators and pacemakers. J Cardiovasc Nurs. 2015;30(5):428–34.

    Article  PubMed  Google Scholar 

  55. Piau A, Campo E, Rumeau P, Vellas B, Nourhashemi F. Aging society and gerontechnology: a solution for an independent living? J Nutr Health Aging. 2014;18(1):97–112.

    Article  CAS  PubMed  Google Scholar 

  56. IMS Institute for Healthcare Informatics. Patient Apps for improved healthcare from novelty to mainstream. Parsippany, NJ 2013.

  57. IMS Institute for Healthcare Informatics. Patient adoption of mHealth. Use, evidence and remaining barriers to mainstream acceptance. September 2015 2015.

  58. Charani E, Castro-Sanchez E, Moore LS, Holmes A. Do smartphone applications in healthcare require a governance and legal framework? It depends on the application! BMC Med. 2014;12:29.

    Article  PubMed  PubMed Central  Google Scholar 

  59. Masterson Creber R, Maurer MS, Reading M, Hiraldo G, Hickey KT, Iribarren S. Review and analysis of existing mobile phone applications to support heart failure symptom monitoring and self-care using the Mobile Application Rating Scale. JMIR mHealth uHealth. (In Press).

  60. Stoyanov SR, Hides L, Kavanagh DJ, Zelenko O, Tjondronegoro D, Mani M. Mobile app rating scale: a new tool for assessing the quality of health mobile apps. JMIR mHealth uHealth. 2015;3(1), e27.

    Article  PubMed  PubMed Central  Google Scholar 

  61. Centers for Medicare and Medicaid Services. 2015; https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/telehealthsrvcsfctsht.pdf.

  62. Centers for Medicare & Medicaid Services. Frequently Asked Questions about Billing Medicare for Chronic Care Management Services 2016; https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched/Downloads/Payment_for_CCM_Services_FAQ.pdf.

  63. Pinto MR, De Medici S, Napoli C. Ergonomics, gerontechnology and well-being in older patients with cardiovascular disease. Int J Cardiol. 2000;72(2):187–8.

    Article  CAS  PubMed  Google Scholar 

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Acknowledgments

The authors gratefully acknowledge funding for Dr. Masterson Creber by the National Institutes of Health (NIH)/National Institute of Nursing Research (NINR), K99NR016275, “mHealth for Heart Failure Symptom Monitoring.” The Columbia University School of Nursing also provided post-doctoral funding for Dr. Masterson Creber through NIH/NINR (T32NR007969). Additional mentorship training was provided to Dr. Masterson Creber through the Agency for Healthcare Research and Quality (R01HS021816) at the Department of Biomedical Informatics at Columbia University. Dr. Maurer is supported by a K24 Award from the NIA (AG036778) and Dr. Hickey is supported by a R01 Award from NINR (R01 NR014853: iPhone Helping Evaluate Atrial Fibrillation Rhythm Through Technology (iHEART)).

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Correspondence to Ruth M. Masterson Creber.

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Drs Masterson Creber, Hickey, and Maurer have no conflicts of interests to declare

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This article is part of the Topical Collection on Elderly and Heart Disease

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Masterson Creber, R.M., Hickey, K.T. & Maurer, M.S. Gerontechnologies for Older Patients with Heart Failure: What is the Role of Smartphones, Tablets, and Remote Monitoring Devices in Improving Symptom Monitoring and Self-Care Management?. Curr Cardiovasc Risk Rep 10, 30 (2016). https://doi.org/10.1007/s12170-016-0511-8

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